A Simple Bedside Screening Tool for Spasticity Referral
Mallory L Hacker,1,2 Shelby Ploucher,1,3 Aaditi G Naik,1,4 Maxim Turchan,1 Jacqueline C Meystedt,1 Kelly Harper,1 Peter Hedera,1 Claude J Pirtle,5 Kassandra Stubblefield,1 David Charles1 1Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA; 2Department of Physical Medic...
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Dove Medical Press
2020
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oai:doaj.org-article:61efc2398b9f4691b5a3dc838c25a6e22021-12-02T10:01:14ZA Simple Bedside Screening Tool for Spasticity Referral1178-1998https://doaj.org/article/61efc2398b9f4691b5a3dc838c25a6e22020-05-01T00:00:00Zhttps://www.dovepress.com/a-simple-bedside-screening-tool-for-spasticity-referral-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Mallory L Hacker,1,2 Shelby Ploucher,1,3 Aaditi G Naik,1,4 Maxim Turchan,1 Jacqueline C Meystedt,1 Kelly Harper,1 Peter Hedera,1 Claude J Pirtle,5 Kassandra Stubblefield,1 David Charles1 1Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA; 2Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA; 3Florida State University College of Medicine, Tallahassee, FL, USA; 4Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA; 5Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USACorrespondence: Mallory L HackerNeurology and Physical Medicine & Rehabilitation, Vanderbilt University Medical Center, 440 Crystal Terrace, 3319 West End Ave, Nashville, TN 37203, USAEmail mallory.hacker@vumc.orgBackground and Objectives: Spasticity is common in long-term care facilities; however, this often-disabling condition is largely underdiagnosed in this setting and therefore left untreated. This study aimed to test the ability of a three-question flowchart used at the bedside by primary care providers in the long-term care setting to identify residents in need of referral to a specialist for spasticity consultation.Methods: All residents of a single long-term care facility were approached for participation in this cross-sectional, observational study. Spasticity diagnostic evaluations by a movement disorders specialist neurologist (reference standard) were compared with referral determinations made by two primary care providers [a primary care physician (PCP) and a nurse practitioner (NP)] using the simple flowchart.Results: The analysis included 49 residents (80% male, age 78.2± 9.0 years) who were evaluated by the reference standard neurologist and at least one primary care provider. The bedside referral tool demonstrated high sensitivity and moderate specificity when used by the PCP (92% and 78%, respectively; AUC=0.84) and NP (80% and 53%, respectively; AUC=0.67).Conclusion: This simple tool may be useful for primary care providers to identify residents to be referred to a specialist for evaluation and treatment of spasticity. These results warrant further investigation of the potential utility of this screening tool across multiple long-term care facilities and various types of care providers.Keywords: spasticity, neurological disease, long-term care, screening, primary careHacker MLPloucher SNaik AGTurchan MMeystedt JCHarper KHedera PPirtle CJStubblefield KCharles DDove Medical Pressarticlespasticityneurological diseaselong-term carescreeningprimary careGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 15, Pp 655-662 (2020) |
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spasticity neurological disease long-term care screening primary care Geriatrics RC952-954.6 |
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spasticity neurological disease long-term care screening primary care Geriatrics RC952-954.6 Hacker ML Ploucher S Naik AG Turchan M Meystedt JC Harper K Hedera P Pirtle CJ Stubblefield K Charles D A Simple Bedside Screening Tool for Spasticity Referral |
| description |
Mallory L Hacker,1,2 Shelby Ploucher,1,3 Aaditi G Naik,1,4 Maxim Turchan,1 Jacqueline C Meystedt,1 Kelly Harper,1 Peter Hedera,1 Claude J Pirtle,5 Kassandra Stubblefield,1 David Charles1 1Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA; 2Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA; 3Florida State University College of Medicine, Tallahassee, FL, USA; 4Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA; 5Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USACorrespondence: Mallory L HackerNeurology and Physical Medicine & Rehabilitation, Vanderbilt University Medical Center, 440 Crystal Terrace, 3319 West End Ave, Nashville, TN 37203, USAEmail mallory.hacker@vumc.orgBackground and Objectives: Spasticity is common in long-term care facilities; however, this often-disabling condition is largely underdiagnosed in this setting and therefore left untreated. This study aimed to test the ability of a three-question flowchart used at the bedside by primary care providers in the long-term care setting to identify residents in need of referral to a specialist for spasticity consultation.Methods: All residents of a single long-term care facility were approached for participation in this cross-sectional, observational study. Spasticity diagnostic evaluations by a movement disorders specialist neurologist (reference standard) were compared with referral determinations made by two primary care providers [a primary care physician (PCP) and a nurse practitioner (NP)] using the simple flowchart.Results: The analysis included 49 residents (80% male, age 78.2± 9.0 years) who were evaluated by the reference standard neurologist and at least one primary care provider. The bedside referral tool demonstrated high sensitivity and moderate specificity when used by the PCP (92% and 78%, respectively; AUC=0.84) and NP (80% and 53%, respectively; AUC=0.67).Conclusion: This simple tool may be useful for primary care providers to identify residents to be referred to a specialist for evaluation and treatment of spasticity. These results warrant further investigation of the potential utility of this screening tool across multiple long-term care facilities and various types of care providers.Keywords: spasticity, neurological disease, long-term care, screening, primary care |
| format |
article |
| author |
Hacker ML Ploucher S Naik AG Turchan M Meystedt JC Harper K Hedera P Pirtle CJ Stubblefield K Charles D |
| author_facet |
Hacker ML Ploucher S Naik AG Turchan M Meystedt JC Harper K Hedera P Pirtle CJ Stubblefield K Charles D |
| author_sort |
Hacker ML |
| title |
A Simple Bedside Screening Tool for Spasticity Referral |
| title_short |
A Simple Bedside Screening Tool for Spasticity Referral |
| title_full |
A Simple Bedside Screening Tool for Spasticity Referral |
| title_fullStr |
A Simple Bedside Screening Tool for Spasticity Referral |
| title_full_unstemmed |
A Simple Bedside Screening Tool for Spasticity Referral |
| title_sort |
simple bedside screening tool for spasticity referral |
| publisher |
Dove Medical Press |
| publishDate |
2020 |
| url |
https://doaj.org/article/61efc2398b9f4691b5a3dc838c25a6e2 |
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